We need health care ethics in environmental justice, and we need environmental ethics in health care justice.
Over the last few months, much of the U.S., particularly in the South, experienced severe winter weather and unusual, if not unprecedented, storms. The storms hit Texas hard, impacting life, health and the pandemic response. And residents in Jackson, Miss., endured weeks in February and into March without clean running water—a problem caused by the one-two punch of heavy storms and crumbling infrastructure.
For disabled people, the storms were particularly dangerous. Without electricity, people were without medication, mobility and medical devices, and dangerous road conditions left people trapped without access to in-home or delivery services. Rafael Garcia told Disability Rights Texas that he was afraid of what could happen as he was forced to ration breathing treatments.
Extreme Weather and Pandemic Response
While such events always impact health and life of the people involved (particularly disabled people with unique and neglected needs), in the midst of the pandemic and vaccine rollout, they impacted us all with ramifications for all aspects of the efforts to contain the pandemic and care for those who are ill.
As with the wildland fires of the summer and fall, storms and power outages forced people to gather in shelters, this time for warmth—increasing the risk of COVID-19 exposure and making it challenging for people to quarantine or isolate. For people recovering at home, cold temperatures and lack of power took away medical supports and worsened symptoms. For those in hospitals, doctors describe being more overwhelmed by the storms than by previous COVID-19 surges. Coping with a lack of running or potable water, health care providers were forced to ration or postpone care like dialysis. Outside hospitals, ambulances had difficulty reaching those in need or transferring patients between facilities.
Even as vaccine rollout offers hope and an end in sight for the pandemic, storms complicated this as well. In many places nationwide, storms delayed vaccination clinics‘ operations. Even some seemingly unaffected areas still had to reschedule clinics due to grounded shipments. The additional work created by rescheduling appointments was discussed by British health care providers late last year as their government changed vaccination guidelines. While unavoidable with the extreme weather, this nevertheless created additional work for state, county and tribal health authorities that have been working in emergency mode for the past year and have continued to manage high, if falling, case counts.
Health Care Ethics in Environmental Justice, and Environmental Ethics in Health Care Justice
The impact of environmental factors and climate change on public health and individuals is not new. Environmental racism has profound health impacts on communities of color and often does not get the level of attention it deserves. The effects of climate change have already been felt by Indigenous communities around the world. And for many of these communities, the relationship between the environment and pandemic response has been a problem since the beginning. For the Navajo Nation, the lasting effects of mining on their lands has left communities without water for sanitation as their community experienced devastating losses from COVID-19.
Ultimately, these storms, much like the pandemic, demonstrate just how interconnected our society and the world are. In Texas, a cultural emphasis on self-reliance made the situation so much more dire than in other states experiencing unusually harsh winter weather. The COVID-19 pandemic has also highlighted the dangers of a culture overly focused on individualism and self-reliance, key values questions that have been raised in debates over mask mandates.
As we move forward with climate change mitigation, ending the COVID-19 pandemic and continuing to prepare for emerging infectious diseases, we need to remember the limitations of self-reliance and acknowledge the profound impact of a changing climate on our other public health efforts— whether it’s continued prevention of emerging infectious diseases or addressing deeper health inequities with food sovereignty, affordability of care, access to home health, reproductive choice and disability rights.
In her book, An Invitation to Feminist Ethics, Hilde Lindeman describes a “webs of relationships,” urging a medical ethics that value and see the patient’s relationships to family, friends and community. We need to bring thinking to addressing these big, interconnected problems that consider these multidirectional connections we all have. For many, the pandemic has demonstrated how interconnected we are in ways that were not previously so tangible, and that awareness should inform our response to the problems we are facing.
Our health care system must be prepared for climate change, natural disasters and extreme weather—and the specific impacts of those events on underserved and historically marginalized communities including Indigenous communities, people with disabilities, the unhoused and rural populations.
And our climate change mitigation strategies must address the impacts on public health, again with attention to historically marginalized communities. We need health care ethics in environmental justice, and we need environmental ethics in health care justice. The relationship between health and the environment is not new, and now, with so much policy and both national and international discourse focused on public health and climate change, it is imperative that we draw on comprehensive ethical frameworks in writing and evaluating policy.
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